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This bypasses the effect stomach acid exerts on peptides when taken orally, degrading the peptides and decreasing efficacy

Most TCM studies have focused on downstream effects (e.g., upregulating Nrf2/GPX4) but fail to identify active ingredients or their direct binding partners, hindering standardized development and clinical approval

However, pure MDM4 inhibitors and MDM2/4 bispecific inhibitors are lacking, and further exploration of new effective drugs is still needed

Taken together, while these natural products exhibit potential biological activity relevant to DOR, current evidence remains preliminary and largely exploratory